SPORTS

REHABILITATION
matthew rex acosta madayag, md
physiatrist

SPORTS REHABILITATION
- multi-disciplinary approach to treat injuries
sustained through sports participation so the
athlete can regain normal pain-free mobility
- Primary goal: return to pre-injury activities

Phases of Sports Rehabilitation

Phase I: Resolving pain and inflammation

Phase II: Restoring range of motion
Phase III: Strengthening
Phase IV: Proprioceptive training
Phase V: Sports/task specific activities

Phase I: Resolving pain and

inflammation
Control the inflammatory reaction
1.
2.
3.
4.
5.

P protection
R rest
I ice
C compression
E- elevation

Phase I: Resolving pain and

inflammation
Protection
Splinting
Bracing
Taping/wrapping

Rest
Relative rest
Affected area is rested, the remainder of the body is
exercised

Phase I: Resolving pain and

inflammation
Ice
Control the initial inflammatory
response
Facilitates pain control
20 minutes 4 to 5 times/day

Compression
Limit the edema
Ice wrapping
Compressive stockinette

Phase I: Resolving pain and

inflammation
Elevation
Control post injury swelling
Above the level of the heart to optimally assist
with venous and lymphatic drainage

NSAIDs and TENS can assist with both

inflammation and pain control

Phase II: Restoring range of motion

ROM allows for controlled stress which will
stimulate proper collagen deposition.
Pain free movement of a joint and stretching is
encouraged to prevent contracture.

Phase III: Strengthening

Early post-injury phase isometric
contractions
10 seconds contraction; 10 reps; 10x/day

ROM recovers isotonic strengthening

Resistance training
Against gravity
Weights
Resistance tubing

Phase IV: Proprioceptive training

Dynamic motor control
Simple proprioceptive training
Seated exercises with wobble board for LE injuries
Loading exercises of the arm

Phase V: Sports/task specific activities

Occurs as the athlete successfully meets the
challenges of the previous phases

REHABILITATION OF INJURED ATHLETES:

ACUTE phase: PRICE, TENS, protected ROM,
static and closed kinetic chain exercises
(isometrics), general conditioning ex, NSAIDs
RECOVERY phase: USD, TENS, HMP, AROM, PNF,
dynamic strengthening, sports specific ex
FUNCTIONAL phase: plyometric exercise,
flexibility strengthening, power and
endurance, sport specific progression ex,
return to sports

SPORTS REHABILITATION
Most common sports injuries SPRAINS and
STRAINS
SPRAIN- injury to the ligaments caused by
overstretching or tearing
STRAIN- injury or tear to the muscle and/or
tendon

Cervical Spine Injuries In Sports

Results when the accelerating head
& neck strike a stationary object
Associated with axial loading of
flexed cervical spine
Burner or stinger- a transient
neurologic event characterized by
pain and paresthesia in a single upper
limb following a blow to the neck or shoulder

Cervical Spine Injuries In Sports

May result from strain,
sprain or tetraplegia (SCI)

Cervical Spine Injuries In Sports

Cervical Disc
- Most common: C5-C6
Acute disc herniation
- Special tests:
Spurlings test : radiculopathy
Shoulder abduction test: relief

Cervical Spine Injuries In Sports

Treatment:
in acute injuries- immobilization (protection)
in severe cases: X-ray cervical spine
in recovery phase: modalities
stretching
Calliet neck ex

Shoulder
Rotator Cuff Injury= overuse syndrome
- baseball, tennis, swimming, etc...
- LOM, ms weakness, pain,
clicking sound
- if with tears,supraspinatus ms
- morphology of acromion in
relation to rotator cuff tear
- type 1= flat
- type 2= curved
- type 3= hooked

Shoulder
Shoulder Impingement syndrome:
- most common cause of shoulder pain
- subacromial space narrowing causing
compression and inflammation on subacromial
bursa, biceps tendon and SITS ms

Shoulder
Special tests for impingement syndrome
- Neers impingement sign- passively flex the
arm > 90 degrees, if with pain, supraspinatus
tendon is compressed between acromion and
greater tuberosity
- Hawkins sign- same as above but with IR of
shoulder. Supraspinatus tendon is compressed
against the coracoacromial jt
- painful arc syndrome- arm pain in abduction
60-120 degrees

Shoulder
Special tests for rotator cuff tears
Drop arm test- passively abduct shoulder with
IR. Pt unable to maintain abduction due to
complete tear of rotator cuff. (deltoids will
initially hold abduction but fails eventually)

Shoulder
Shoulder Dislocation
Anterior dislocation:
excessive ER and
abduction

Posterior dislocation:
fall on the forward
flexed and adducted
arm

Shoulder
Rehabilitation
Pain control and inflammation reduction
Restoration of motion: but limit movements that
would increase the chances of dislocation
Strengthening
Proprioceptive training
Return to task
in case of recurrent shoulder dislocation: refer to
orthopedic surgeon for closed reduction or
possible surgery

Elbow
Tendinitis
Lateral epicondylitis: tennis elbow
Extensor carpi radialis brevis and Extensor
digitorum communis
Pain is 1-2 cm distal to the lateral epicondyle
Pain with resisted extension (Cozens test)
Mgt= ice, rest, PT, counterforce brace

Elbow
Medial epicondylitis: golfers elbow/ little
leaguers elbow in children
Inflammation of the common flexor tendons origin

Wrist and Hand

Wrist fractures
Scaphoid-Most commonly fractured carpal bones
Lunate- most commonly dislocated carpal bone
Distal radius fracture

Wrist and Hand

Ligamentous Injuries of the thumb
Gamekeepers thumb
Ulnar collateral ligament of CMC jt
Grade
I pain and no increased motion
II increased opening with pain on stressing
III no pain from the absence of an intact ligament and
continued motion while stressing

Wrist and Hand

De Quervains Stenosing Tenosynovitis
- Inflammation of the 1st dorsal compartment (APL
EPB tendons)
- Overuse gripped and wrist ulnar deviated
- Radial wrist pain is noted with resisted
thumb extension
- Finkelsteins test

Wrist and Hand

Injuries to the digits
- Mallet finger rupture of extensor tendon
- Jersey finger- rupture of flexor tendon at its
insertion

Hip
Hip Pointer
- Direct blow to the pelvic brim
or hip region which results in a
contusion to the soft tissues and
underlying bone ( bleeding in
hip abductors)
- Contact sports such as football
and hockey
- lasts for 1-6 wks depending on
the severity
- Tx: icing, active ROM, rest

Knee
Patellofemoral Pain Syndrome (PFPS)
-

bikers or runners knee

Most common anterior knee pain syndrome
Overuse injury by repeated microtrauma
due to vastus lateralis tightness
and medial weakness

Knee
Patellofemoral pain Syndrome
Vastus Medialis Obliquos ( VMO) Insufficiency
Help maintain proper patella tracking during extension
of the knee
Dynamic medial stabilizer

ITB tightness
Abnormal patellar tracking

Hamstring tightness
Increase patellofemoral joint reaction force in stance

Knee
Patellofemoral pain Syndrome
Treatment:
Ice, NSAIDs
Avoid kneeling, excessive stair climbing and prolonged
sitting
Proper stretching (vastus lateralis, ITB and hamstrings)
VMO strenghtening
Patellar mobilization technique

Knee
Anterior Cruciate Ligament Injury
- most common ligament injured in athletics
- MOI: knee hyperextension injury or deceleration
injury
- most commonly in landing flat on their heels
Unhappy triad: ACL, MCL, medial meniscus
Common with rotatory activity
PE: anterior drawer test or
Lachmann test

Knee
Anterior Cruciate Ligament Injury
- women> men : due to general muscular
strength, reaction time of muscle contraction
and coordination, and training techniques
- Dx: MRI
- Sx: sudden popping sound, swelling, and
instability of the knee
- conservative mgt: strengthening of
hamstrings and knee braces
- surgery: ACL reconstruction

Knee
ACL - post operative rehabilitation phases
Phase 1: reduce pain and swelling while gaining ROM
Phase 2: 3-4 wks, mini wall sits and stationary bike,
ROM upto 100 degrees flexion
Phase 3: 4-6 wks, controlled ambulation phase, flexion
to 130 degrees, aim is to improve balance
Phase 4: 6-8 wks, moderate protection phase, full ROM
with resistance training regimen
Phase 5: 8-10 wks, light activity phase, strengthening
with balance and mobility
Phase 6: 10 wks ---, return to activity phase, jogging to
return to sports

Knee
Posterior Cruciate Ligament
- direct impact to the front of the tibia itself, usually
when the knee is bent
- (+) posterior drawer sign most sensitive test for
PCL
- (+) posterior sag test
- Surgical
- Strengthening of quads

Knee
Meniscal tear
- Direct blow to the knee/twisting type of knee
- Swelling, tightness
- Symptoms increase with
knee flexion & localized
to the joint line
- McMurray test
- Appley compression test

Knee
Meniscal tear
- Conservative mgt: RICE, NSAIDS, electrotherapy,
quadriceps strengthening, glucosamine sulfate
- Surgery: arthroscopic surgery
preserve as much of the meniscus cartilage as
possible

Knee
Medial and lateral Collateral ligament injuries:

- Medial > lateral

- (+) varus / valgus stress test
- (+) appley distraction test

Ankle
Achilles Tendinitis
Inflammatory reaction
Running is the most commonly associated activity
Overuse most common cause
Treatment:
Decrease inflammation
Stretching of the gastrocnemius/soleus complex
Eccentric strengthening

Ankle
Inversion ankle sprain
- Most common traumatic injuries
- Lateral ligament
- Grade:
I mild sprain of the anterior talofibular ; (-) anterior
drawer and talar tilt test
II disruption of the anterior talofibular with sprain of
the calcaneofibular, (+) ant drawer test , (-) talar tilt
III disruption of the lateral ligament complex with (+)
ankle drawer and talar tilt test

Ankle
Deltoid Ligament Injuries
Eversion injury
Occur concomitantly with
inversion injury

Treatment
Ice, NSAIDs, relative rest, early mobilization
Strengthening, proprioceptive exercises

Foot
Plantar Fasciitis
- Sudden loading of the feet
Occur in both a pes planus foot and pes cavus foot
Focal tenderness at the origin of plantar fascia
Pain elicited by hyperdorsiflexion of the great toe
Tightness of gastrocnemius comples
Treatment
Aggressive stretching
Strengthening exercises

Thank you